In 2005, the federal government implemented the “Recovery Audit Contract (RAC),” a new control process intended to address the billions of dollars of improper and fraudulent medical claims that occur each year. To accomplish this, the government hired private auditing companies to perform audits on medical records and claims billing in all 50 states. Audits may cover any provider who bills fee-for-service Medicare, Medicaid, or commercial insurance programs. The audits will check for evidence of fraud by examining three common indicators of fraud: 1) coding inconsistencies; 2) documentation to support the medical necessity of the services provided; and 3) overpayments or underpayments to providers.
This can be a critical procedure for all medical practices. If your practice’s claims and records are audited and any of the three inconsistencies are found, you may be required to pay back not only the overpayment but also interest. Appeals may or may not be successful. The auditing companies will continue to audit your practice every 45 days until they find no further evidence of fraud.
Why take a risk in your practice? Begin using our MD Audit Shield services to eliminate the chances of an audit proving inconsistencies in your billing. While nothing will keep the government from auditing your practice, our MD Audit Shield service will at least protect your practice in several ways. MD Audit Shield takes the following steps to ensure your compliance:
It reviews 50 records at random from your billing to check if any improper coding and non-compliance issues with Medicare/Medicaid appear.
It specifies what corrective actions are needed to comply with codes.
It performs any necessary changes to put you in compliance.
It stands behind you with assistance in the event you are audited.
Please contact us today to prepare for RAC auditing.